Elbow Pain in Little League Pitchers

Condition: “Little League elbow”, which is referred to by the medical term medial epicondyle apophysitis, is elbow pain in any young overhead-throwing athlete, such as Little League baseball pitchers.

Background: During the overhead throwing motion, stress occurs at the elbow joint, and over time, this stress can lead to damage to the structure of the elbow and tearing of the growth plate.

Risk Factors: This injury is most often diagnosed in athletes under the age of 16. Increased pitching time is associated with an increased risk of injury; thus, youth baseball leagues have adopted pitch count limits and mandated rest days to protect the young players. Early use of the curve ball may increase the chances of this injury. Athletes that reside in warmer climates often play the sport year-round with limited rest, making them particularly prone to this injury.

History and Symptoms: Young athletes typically experience elbow pain and decreased throwing speed and distance. Information regarding position played, training schedule, number of teams, estimate of innings/pitches per week, prior injuries, participation in other sports, and pain at night is critical.

Physical Exam: A physical exam will be used to assess the range of motion, strength, flexibility, and nerve function in the affected elbow. The physician will examine the elbow for structural problems and swelling. A full assessment of the throwing motion should also be made.

Diagnostic Process: Special tests that create stress at the elbow can be performed. X-rays of the elbow are commonly used, especially to determine the severity of the injury. MRI and ultrasound can also be used to provide a more detailed assessment.

Rehab Management: Ice and anti-inflammatory medications are useful to ease symptoms. Immobilization can be helpful in cases of severe pain. Approximately 4-6 weeks of rest from all throwing activities is recommended. During this time, active exercise is encouraged. Surgery may be required for severe injuries. When motion becomes pain-free, strengthening exercises will be initiated followed by re-introduction of throwing. Athletes are typically allowed to return to participation after approximately 12 weeks.

Other Resources for Patients and Families: The patient and family should receive counseling on prevention strategies. The USA Baseball Medical and Safety Advisory Committee has published recommendations for youth pitch counts. Coaches, parents, and players should work together with medical specialists to ensure that the player completes rehabilitation before returning to play.